Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Friday, November 02, 2007

A maggot is a fly larva that enjoys feeding on dead flesh. They look sort-of like large grains of rice that wiggle.

If you have been in medicine for a few years, you will probably have seen maggots chewing on some guy’s foot ulcer. This is sounds pretty nasty, but in truth, maggots can be helpful. They will clean away dead tissue and prevent infection. They have been used for millennia for wound debridement and are still used today in some settings. As recently as WWII, in the days of limited antibiotic availability, wards of soldiers would have maggots applied to open wounds, saving life and limb.

I recently got a foot amputation specimen in the pathology lab. This had a deep heel ulcer extending to the bone (don’t get diabetes people!). I cut into the wound and hundreds of maggots poured out. My instinct was to puke, but then I recalled my admiration for these humble creatures. I sectioned and sampled the foot then placed it in a large jar of formaldehyde. My respect for fly larva was about to grow.

Formaldehyde (or Formalin) is a chemical agent used for fixing tissues. This roughly means that it stops meat from rotting. It turns human tissue firm (M.D.s will recall the feel of the bodies in gross anatomy – in a non-sexual way, we hope) and disinfects by killing organisms. In fact, it is such a good disinfectant that - at least according to the texts that I have read – everything is killed with the possible exception of prions (these cause the spongiform encephalopathies such as ‘mad-cow’, wasting disease of elk, kuru, fatal familial insomnia, scrapie, Gerstmann-Straussler-Scheinker and Creuzfeldt-Jacob disease. These are called ‘spongiform’ because when you cut up the brains of people and animals with these conditions, they have holes like a sponge – so, aside from not getting diabetes, please don’t ritualistically eat the brains of the dead like the Fore tribe in Papua New Guinea, ok!).

Anyway, two days after I put the foot in formalin, I went back to pull out an old specimen and I saw something moving in one of the adjacent jars. When I looked closer, it was the maggots swimming happily around, like a miniature koi pond filled with animated rice grains. Again, I gulped the vomit from the back of my throat; my heart filled with love for these beautiful infant flies. I thought to myself: ‘cockroaches are pussies’, and went back to work.

29 comments:

Etop, don't forget about leeches!! They are still used in clinical settings such as re-implantion of digits, large surface are skin grafts and such to decrease venous congestion! Oh, I forget, those are live people we're working on..You don't see live people....

My favorite bug story was cleaning all the maggots from a patient who had stroked out in a field in a rural area and survived for 5 days in the field with no food nor water. He said in his broken sentences that he stroked, fell off his riding lawnmower in the field and spent the first couple of days trying to drag himself back to the house to call 9-11. After the first couple of days, he just lay there waiting. Medics said it looked like he dragged himself 200 yards. Finally his family came to check on him and found him there.

Bugs in general (I'm fairly certain maggots were involved) ate away at his skin alive until large, gaping holes were there that needed to be packed every day. He arrived covered in dirty, grime, and bugs and needed the full body shave, etc in addition to major fluid resuscitation etc etc.

Several years ago, the NIH did a similar experiment with Yellow Page attorneys. They put two groups in formalin, and the ones facing the TV with an ambulance driving down the road were somehow able to survive.

Maggots are cool! I did wound care in an LTAC where our specialty was maggot debriedment. Toss the little buggers in the wound, cover with guaze and water every 3 hours, and in a few days what was a necrotic wound is now nice and pink!

Etotheipi: Why don't you and your little poet drop by my place and give me some good input? Professional input on the xanthochromia issue I have posted on my blog, that is. Seriously, I'd like an MD point of view from you or anyone else who cares to comment.

We just had a patient present with an I&D that was completed 3 years ago, with the original bandage still on her wound! We gowned, masked, bootied up, got the vicks vapor rub under our noses, put the winter green oil on tubs of guaze and headed in expecting the worst. Well, we were right about the smell, but once we pulled off the nasty (and stanking) little bandage, and got over the hundreds of little maggots in her wound, what a surprise to see that the wound itself was cleaner than just about any wound Ihave ever seen! Those maggots saved her leg and prolly her life.

"Don't get diabetes people." can't believe nobody's commented taking offense to that! You and I know what you mean, but non-medical? "Uhoh...I can "get" diabetes? Do I need to wash my hands more, like I do to keep away from the MRSAbug???" and "you arrogant doctor, it's about hormones...you don't "get" diabetes, you just have it or not!!!"

If someone doesn't 'get' the "don't get diabetes" comment, then they should not be reading this blog because they are literal minded dipshits.

Although my comment was basically ironic / sarcastic, you actually CAN, in a sense, GET diabetes. Type 2 diabetes is often directly related to obesity - many people who lose weight, lose the diabetes.

So there.

Oh yeah, I forgot to mention that you will likely get some combination of Ebola and 'flesh eating' staph if you don't wash your hands and genitals on an hourly basis. I certainly do this, although it has nothing to do with disease avoidance.

By the way, you might be surprised to learn that Type I Diabetes can be caused by a Coxsackie B infection (hypothetically). So there, you have something to avoid like the MRSA bug (something which I'm sure you heard on House MD). And lay off doctors you arrogant nooblet!